skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Gallium-67 imaging in human heart transplantation: correlation with endomyocardial biopsy

Abstract

Endomyocardial biopsy seems to be the most accurate method to use for diagnosis and follow-up of acute rejection of the transplanted heart. This investigation compared a noninvasive procedure, gallium-67 imaging, with endomyocardial biopsy in the detection of acute rejection in heart transplantation. Seven male patients (aged 41 to 54 years) sequentially had 46 gallium-67 scintigrams and 46 endomyocardial biopsies between 1 week and 8 months after transplantation. Both studies were obtained in the same day, 48 hours after the administration of an intravenous injection of gallium-67 citrate. Cardiac uptake was graded as negative, mild, moderate, and marked according to an increasing count ratio with rib and sternal uptakes. Histologic findings were graded as negative, mild acute rejection, moderate acute rejection, severe acute rejection, resolving rejection, and nonspecific reaction. Negative biopsies were not found with moderate uptake, and neither moderate nor severe acute rejection were found with negative scintigrams. Imaging sensitivity was 83% with 17% false negatives and 9% false positives. Of seven studies with moderate uptake, five showed moderate acute rejection, and the patients had specific therapy with a decline in uptake, which correlated with resolving rejection. It is conceivable that in the future this technique may be used asmore » a screening procedure for sequential endomyocardial biopsies in the follow-up of heart transplant patients.« less

Authors:
; ; ; ; ; ; ; ; ;
Publication Date:
Research Org.:
Universidade de Sao Paulo, Brazil
OSTI Identifier:
5627779
Alternate Identifier(s):
OSTI ID: 5627779
Resource Type:
Journal Article
Resource Relation:
Journal Name: J. of Heart Transplant.; (United States); Journal Volume: 6:3
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; GRAFT-HOST REACTION; DIAGNOSIS; HEART; SCINTISCANNING; TRANSPLANTS; BIOPSY; CORRELATIONS; GALLIUM 67; INTRAVENOUS INJECTION; MAN; MYOCARDIUM; PATIENTS; ANIMALS; BETA DECAY RADIOISOTOPES; BODY; CARDIOVASCULAR SYSTEM; COUNTING TECHNIQUES; DAYS LIVING RADIOISOTOPES; DIAGNOSTIC TECHNIQUES; ELECTRON CAPTURE RADIOISOTOPES; GALLIUM ISOTOPES; INJECTION; INTAKE; INTERMEDIATE MASS NUCLEI; ISOTOPES; MAMMALS; MUSCLES; NUCLEI; ODD-EVEN NUCLEI; ORGANS; PRIMATES; RADIOISOTOPE SCANNING; RADIOISOTOPES; VERTEBRATES 550601* -- Medicine-- Unsealed Radionuclides in Diagnostics

Citation Formats

Meneguetti, J.C., Camargo, E.E., Soares, J. Jr., Bellotti, G., Bocchi, E., Higuchi, M.L., Stolff, N., Hironaka, F.H., Buchpiguel, C.A., and Pileggi, F. Gallium-67 imaging in human heart transplantation: correlation with endomyocardial biopsy. United States: N. p., 1987. Web.
Meneguetti, J.C., Camargo, E.E., Soares, J. Jr., Bellotti, G., Bocchi, E., Higuchi, M.L., Stolff, N., Hironaka, F.H., Buchpiguel, C.A., & Pileggi, F. Gallium-67 imaging in human heart transplantation: correlation with endomyocardial biopsy. United States.
Meneguetti, J.C., Camargo, E.E., Soares, J. Jr., Bellotti, G., Bocchi, E., Higuchi, M.L., Stolff, N., Hironaka, F.H., Buchpiguel, C.A., and Pileggi, F. Fri . "Gallium-67 imaging in human heart transplantation: correlation with endomyocardial biopsy". United States. doi:.
@article{osti_5627779,
title = {Gallium-67 imaging in human heart transplantation: correlation with endomyocardial biopsy},
author = {Meneguetti, J.C. and Camargo, E.E. and Soares, J. Jr. and Bellotti, G. and Bocchi, E. and Higuchi, M.L. and Stolff, N. and Hironaka, F.H. and Buchpiguel, C.A. and Pileggi, F.},
abstractNote = {Endomyocardial biopsy seems to be the most accurate method to use for diagnosis and follow-up of acute rejection of the transplanted heart. This investigation compared a noninvasive procedure, gallium-67 imaging, with endomyocardial biopsy in the detection of acute rejection in heart transplantation. Seven male patients (aged 41 to 54 years) sequentially had 46 gallium-67 scintigrams and 46 endomyocardial biopsies between 1 week and 8 months after transplantation. Both studies were obtained in the same day, 48 hours after the administration of an intravenous injection of gallium-67 citrate. Cardiac uptake was graded as negative, mild, moderate, and marked according to an increasing count ratio with rib and sternal uptakes. Histologic findings were graded as negative, mild acute rejection, moderate acute rejection, severe acute rejection, resolving rejection, and nonspecific reaction. Negative biopsies were not found with moderate uptake, and neither moderate nor severe acute rejection were found with negative scintigrams. Imaging sensitivity was 83% with 17% false negatives and 9% false positives. Of seven studies with moderate uptake, five showed moderate acute rejection, and the patients had specific therapy with a decline in uptake, which correlated with resolving rejection. It is conceivable that in the future this technique may be used as a screening procedure for sequential endomyocardial biopsies in the follow-up of heart transplant patients.},
doi = {},
journal = {J. of Heart Transplant.; (United States)},
number = ,
volume = 6:3,
place = {United States},
year = {Fri May 01 00:00:00 EDT 1987},
month = {Fri May 01 00:00:00 EDT 1987}
}
  • We report the findings of a patient with post-cardiac transplant mediastinitis detected by {sup 67}Ga-citrate imaging. Fever and leukocytosis were the first clinical signs suggesting infection. The usual diagnostic modalities, including CT and ultrasound, failed to identify the site of infection. A {sup 67}Ga scan showed intense abnormal uptake behind the sternum. The site of uptake was shown by necropsy to be necrotic tissue involving cardiac sutures, pulmonary arteries, and the aorta due to infection with Haemophilus aphrophilus.
  • Current standards for detection of myocarditis in a clinical setting rely on endomyocardial biopsy for accurate diagnosis. With this technique a subset of patients with dilated cardiomyopathy show unsuspected myocarditis histologically. Endomyocardial biopsy, despite its specificity, may lack sensitivity due to sampling error if the inflammation is patchy or focal. Therefore, inflammation-sensitive radioisotopic imaging may be a useful adjunct in the diagnosis of myocarditis. This study was designed to evaluate the applicability of gallium-67 (67Ga) myocardial imaging as an adjunct to endomyocardial biopsy in the diagnosis of myocarditis. Sixty-eight consecutive patients referred for evaluation of dilated cardiomyopathy underwent 71 parallelmore » studies with 67Ga imaging and biopsies that served as the basis of comparison for this study. Histologic myocarditis was identified in 8% of biopsy specimens. Clinical and hemodynamic parameters could not be used to predict the presence of myocarditis. Five of six biopsy samples (87%) with myocarditis showed dense 67Ga uptake, whereas only nine of 65 negative biopsy samples (14%) were paired with equivocally positive 67Ga scans. The single patient with myocarditis and no myocardial 67Ga uptake had dense mediastinal lymph node uptake that may have obscured cardiac uptake. The incidence of myocarditis on biopsy with a positive 67Ga scan was 36% (5/14); however, the incidence of myocarditis with a negative 67Ga scan was only 1.8% (1/57). Follow-up scans for three patients showed close correlation of 67Ga uptake with myocarditis on biopsy. In conclusion 67Ga may be a useful screening test for identifying patients with a high yield of myocarditis on biopsy, and serial scans may eliminate the need for frequent biopsies in patients with proven myocarditis.« less
  • We correlated the results of parotid gland biopsy, chest roentgenograms, and gallium citrate scintigraphy in 24 patients evaluated for possible systemic sarcoidosis. Of 19 patients ultimately proven to have sarcoidosis, 11 (57.9 percent) had positive parotid gland biopsy. The yield of parotid gland biopsy in patients with abnormal gallium parotid activity was only marginally higher (64.7 percent). Abnormal parotid gland uptake of gallium citrate was seen in 17 of these 19 patients (89.5 percent) and was always associated with abnormal lung or perihilar activity. The parotid gland biopsy is a useful technique for obtaining the tissue diagnosis of sarcoidosis; however,more » gallium scintigraphy should not be performed to select patients as this will only marginally increase the biopsy yield.« less
  • Radioactive gallium-67 (Ga-67) has been shown to accumulate within areas of pericardial inflammation. The present study estimated prospectively the prevalence and clinical significance of Ga-67 uptake in the heart in 62 patients 10 to 16 days after open-heart surgery. Of 62 patients studied, markedly diffuse Ga-67 uptake was detected in 21 (34%) and focal or mild diffuse uptake in 23 (37%). Results were negative in 18 (29%). Nine patients with a negative scan result (50%) had received corticosteroid therapy before imaging, whereas only 2 patients with a positive scan result (5%) were receiving steroids. The erythrocyte sedimentation rate and C-reactivemore » protein level were both higher in patients with Ga-67 uptake compared with those with a negative scan result (p less than 0.01 in both). No other clinical, echocardiographic or electrocardiographic indicators of postpericardiotomy syndrome were related to Ga-67 uptake. No patient developed cardiac tamponade or constrictive pericarditis during the 12-week follow-up and the Ga-67 scan results did not predict the occlusion of coronary artery bypass grafts. Thus, pericardial inflammation manifested as Ga-67 uptake is a common finding after open-heart surgery and appears to be a benign condition.« less
  • Scintigraphy has demonstrated gallium-67 accumulation within the heart in pericarditis and cardiomopathies of various kinds. A case report is presented of a 63-yr-old man with multisystem disease who showed extensive myocardial uptake of Ga-67 by scintigraphy. At autopsy, constrictive pericarditis with myocardial fibrosis was found. Gallium-67 localzation has not been documented previously in myocarial fibrosis accompanying constrictive pericarditis.